RI指数联合超声对孕晚期胎儿肾积水预后预测价值的研究

目的探讨RI指数联合超声对孕晚期胎儿肾积水预后预测的价值.方法选取行超声检查发现的晚孕期肾积水胎儿141例,检测胎儿的肾实质厚度、肾盂前后直径(APD)、肾盂肾盏形态,并给予评分,累计3项指标评分分值;对胎儿行超声检查时测定积水肾脏肾门位置的RI值.将以上检测结果与胎儿出生后1 a内行超声检查和临床诊断结果进行对照研究.结果 141例胎儿共有170只肾积水;出生后1 a内行超声检查和临床诊断显示,非病理性肾积水121只,病理性49只.随着超声评分值增加,病理性肾积水风险越高,其中超声评分≤3分均为非病理性肾积水,评分≥8分均为病理性肾积水.病理性肾积水与非病理性肾积水超声评分之间差异具有显著统计学意义(P0.01).超声评分为5分时,为辨别诊断非病理性肾积水和病理性肾积水的截断值,特异度为88.61%,灵敏度为95.00%.超声评分≤5分的肾积水胎儿的肾动脉RI值在0.60~0.67,而超声评分5分的肾积水胎儿肾动脉RI值在0.70~0.78.结论超声评分法联合RI指数评估胎儿肾积水预后客观准确,具有较高实用价值,超声评分5分为诊断胎儿病理性肾积水的最佳截断值.

On Ultrasonic Scoring Method Combined with RI Index on Evaluation Value of Fetal Hydronephrosis Prognosis in Late Pregnancy

Objective To investigate the value of ultrasonic scoring method combined with renal artery resistance index ( RI) on the evaluation of fetal hydronephrosis prognosis in late pregnancy. Method 141 cases of late pregnancy fetal hydronephrosis was detected. The thickness of renal parenchyma, fetal renal pelvic diameter (APD), pelvicaliceal morphology were measured and scored, and the total score of three indicators was calculated. The RI value of water renal door position of the fetus was tested during ultrasonic inspection. The above results,the clinical results and clinical diagnosis of the fetus after birth within 1 year were compared. Results There were 170 hydronephrosis in 141 cases, with 121 non pathological hydronephrosis and 49 pathological according to the ultrasound examination and clinical diagnosis. With the increase of ultrasonic score, the risk of pathological hydronephrosis rised. The ultrasound score less than 3 point was considered as non pathological hydronephrosis,and the score more than 8 point meant pathological hydronephrosis. The difference between the two conditions was statistically significant (P<0. 01). The score of 5 was the cut-off value for the diagnosis of non pathological hydronephrosis and pathological hydronephrosis,with specificity of 88. 61% and sensitivity of 95%. The RI values of the fetus with ultrasound score no more than 5 point were among 0.60 ~0.67, and the values of the fetus with score more than 5 point were among 0. 70 ~0. 78. Conclusion Ultrasound score combined with RI index is objective, accurate and of high practical value for the assessment of fetal hydronephrosis prognosis. The point of 5 is the best transaction for pathological diagnosis of fetal hydronephrosis by ultrasound score method.